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目的评估表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)药物对于基因突变状态未知的老年晚期肺腺癌患者治疗及生存的影响。方法回顾性分析2011年1月至2013年12月收治的125例EGFR基因状态未知的老年肺腺癌患者的临床病理特征及治疗情况。采用KaplanMeier法进行生存分析,log-rank检验组间生存差异,Cox比例风险模型进行多因素分析。结果 125例患者的中位年龄为69岁(95%CI:65~85)。109例接受了一线化疗,16例接受了一线EGFR-TKIs治疗;120例患者接受了二线治疗,其中化疗62例,TKIs治疗58例;72%的患者在不同治疗阶段接受了EGFR-TKIs治疗。吸烟是影响总生存的独立预后因素(19.1个月和29.5个月,P=0.02),是否采用EGFR-TKIs对于总生存无影响(14.4个月和23.3个月,P=0.53)。不同EGFR-TKIs治疗时机组间生存存在差异,二线接受TKIs治疗患者总生存最具优势(P=0.024)。二线治疗采用EGFRTKIs较化疗获得更长的PFS(11.7个月和4.5个月,P=0.05)。结论对于基因状态未知的老年肺腺癌患者,治疗中是否使用EGFR-TKIs对于总生存无明显影响,但二线治疗采用EGFR-TKIs在总生存上优于其他时机使用。吸烟是影响这部分患者总生存的独立预后因素。
Objective To evaluate the effects of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) on the treatment and survival of elderly patients with advanced lung adenocarcinoma with unknown mutations. Methods The clinical and pathological characteristics and treatment of 125 elderly patients with lung adenocarcinoma with unknown EGFR status from January 2011 to December 2013 were retrospectively analyzed. Survival analysis was performed by KaplanMeier method. Log-rank test was used to test the survival difference and Cox proportional hazards model for multivariate analysis. Results The median age of 125 patients was 69 years (95% CI: 65-85). Of the 109 patients who received first-line chemotherapy, 16 received first-line EGFR-TKIs; 120 received second-line chemotherapy, 62 of which were chemotherapy and 58 of which were TKIs; and 72% of patients received EGFR-TKIs at various stages of treatment. Smoking was an independent prognostic factor affecting overall survival (19.1 and 29.5 months, P = .02). No effect of EGFR-TKIs on overall survival was observed at 14.4 months and 23.3 months (p = 0.53). There was a difference in survival between groups with different EGFR-TKIs and overall survival was most favorable for patients receiving second-line TKIs (P = .024). Second-line treatment achieved longer PFS with chemotherapy than EGFRTKIs (P = .05 for 11.7 and 4.5 months). CONCLUSIONS: EGFR-TKIs have no significant effect on overall survival in elderly patients with lung adenocarcinoma of unknown gene status, but second-line therapy using EGFR-TKIs is superior to other timing in overall survival. Smoking is an independent prognostic factor that affects the overall survival of this subset of patients.